EPISTAXIS ICD 10: Overview, Types, Causes and Treatment

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EPISTAXIS

OVERVIEW

ICD 10 is a billable code used to specify abnormal signs and symptoms, clinical and laboratory findings. It might be used to specify conditions or terms like epistaxis. This code should not be used when the proper diagnosis of a disease has been done. ICD 10 code encodes diseases from head to which are abnormal and not medical explained to be classified in a particular category e.g Epistaxis ICD-10

Type Of Icd-10 Code

  • R00- R99 is used to diagnose disease with abnormal signs and symptoms, clinical findings, and laboratory tests.
  • R00-R09 is used to classify signs and symptoms involving respiratory and circulatory systems
  • R04 has specified for hemorrhage from nose i.e epistaxis.

Epistaxis ICD-10 code is an American version for specifying disease for diagnostic purposes and according to it Diagnostic code for epistaxis is further labeled as R04.

Medical Severity Diagnosis Related Group (MS-DRG)

It involves labeling of disease signs and symptoms not elsewhere explained. It aids in the diagnosis of disease with abnormal findings. Code is designed for all such diseases and code should be considered specific to that disease only.

Epistaxis:

  • DRG150, which is epistaxis with MCC
  • DRG151, which is epistaxis without MCC

ICD-10 Index for Diseases

Index means arranging diseases in ICD 10 code in alphabetical order. For epistaxis, code R04. 0 is given  and related diseases for epistaxis are classified in alphabetical order as

  • Bleeding from nose
  • Epistaxis
  • Hemorrhage concealed
  • Hemorrhage revealed
  • Nasal turbinate
  • Nasal bleeding
  • Postnasal bleeding

All of them have been arranged alphabetically.

What Is Epistaxis Icd-10?

Epistaxis means bleeding from nose. it is common and seen in all age groups children adults and older people. It present as medical emergency and is a sing of underlying nose disease. cause should be identified as soon as possible to prevent recurrent blood loss from nose.

Causes of Epistaxis

The causes may be maybe e divided into local which is in nose or nasopharynx, general and idiopathic, or not known.

Local causes

  • Trauma
  • Infections
  • Neoplasm or cancers
  • Nasal sinuses
  • Viral infections
  • Crust forming diseases
  • Atmospheric changes
  • Deviated nasal septum
  • Hard blowing or sneezing
  • Maggot infestation
  • Sudden decompression(caisson disease)
  • Adenoid inflammation
  • Angiofibroma

General causes

  • CVS disorders
  • Liver disease
  • Kidney diseases
  • Tumors of chest
  • General infections e.g influenza, measles, rheumatic fever, etc.
  • Disorders of blood and blood vessels

Idiopathic Causes

The cause of epistaxis is not known.

SITES OF EPISTAXIS ICD-10:

  • Little’s area, more than 90% of bleeding occurs from this site.
  • Above medial turbinate bleeding occurs from branches of ethmoidal vessels
  • Below medial turbinate, bleeding occurs from sphenopalatine artery
  • Posterior part of the nasal cavity, blood flows into throat directly which patient swallows
  • The anterior part of the nasal cavity
  • Diffuse from vessels in both medial and lateral nasal walls
  • Nasopharynx

Classification of Epistaxis

  1. Anterior epistaxis when blood flows outside the nose.
  2. Posterior epistaxis when blood flows back into the throat. Patients swallow this blood usually and later present as brown colored vomiting.

How to Diagnose?

Most of the time epistaxis needs no diagnosis. it is diagnosed clinically. However, tests are required to diagnose the cause of epistaxis which in some cases may be due to trauma, infections, foreign bodies, maggots or deviated nasal septum and may be related to general conditions of CVS liver, kidney, or drugs.

In any case of epistaxis, it is important to know the

  • mode of onset, that either it is spontaneous or due to trauma
  • duration of bleeding
  • frequency of bleeding
  • amount of blood loss from the nose
  • any history of bleeding tendency inpatient
  • what type of epistaxis it is either anterior or posterior
  • what is the site from which bleeding is occurring
  • family history of bleeding disorder
  • history of CVS diseases, liver diseases e.g liver cirrhosis, nephrotic syndrome
  • drug history for example anticoagulants
  • age of patient either child young adult or age more than 40 years

Treatment

1- First aid

As soon as the bleeding is diagnosed it can easily be controlled by 5 in the nose for about five minutes this compressor vessel and stops bleeding patient is advised to sit with the head placed in backward direction.

2- Anterior nasal packing

Indian is packing is done in case of active anterior epistaxis. minor bleeds are treated conservatively while if bleeding is severe and it is difficult to control, anterior packing should be done. It is done by using Ribbon gauze soaked with liquid paraffin. The whole nasal cavity is packed with gauze in vertical layers. One or both nasal cavities may be packed. Packing is done for 24 hours and if bleeding has stopped it is removed in three to five days. Antibiotics are given to prevent infections and subsidy subsequent septicemia.

3- Posterior nasal packing

It is required for patients bleeding posteriorly where bleeding falls into the throat and the patient swallows it. rubber catheter is passed through the nose,  Silk Threads are tied to end and it is guided into nasopharynx with the index finger. Patients requiring posterior nasal packing should always be hospitalized.

4- Endoscopic Cauterization

Endoscopic cauterization is done when bleeding is localized. The site of bleeding is identified and the vessel is cauterized to stop bleeding, this procedure is safe and lessen Hospital stay but has a back fall that it does not permit generalized bleeding controlled from the nose.

5- surgical ligation of vessels

when bleeding is severe vessels can be ligated or tied to prevent blood loss.

6-embolization

Embolization is done under radiological guidance. embolizing material e.g gel foam is added into the artery to prevent bleeding.

General Measures in Epistaxis Icd-10

  • Ask the patient to sit up with backrest.
  • Reassure the patient.
  • Keep checking pulse, blood pressure, and respiratory rate.
  • Antibiotics given to prevent infection and if nasal packing is done more than 24 hours.
  • Oxygen may be required in patients with both nasal packings.
  • Hemodynamics should be maintained.
  • A blood transfusion may be required.
  • Investigation and treatment for underlying disease.

Conclusion

This system of coding to specify diseases, having signs and symptoms, clinical findings, and laboratory findings abnormal or not explained has made the diagnosis of various diseases easy and reduced the financial strain on patients requiring recurrent tests and investigations to diagnose the disease.